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Nurse Midwifery

Division Director

Celina Cunanan, CNM, MSN; Director of the Division of Nurse-Midwifery, Assistant Clinical Professor; Clinical Instructor of Nursing, Frances Payne Bolton School of Nursing

Faculty

As the only program of its kind in Cleveland, the Division of Nurse-Midwifery at University Hospitals MacDonald Women’s Hospital offers personalized midwifery care with the support of academic affiliate Case Western Reserve University. Our patients receive care from 13 certified Nurse-Midwives and one Women’s Health Nurse Practitioner. As members of the faculty practice in the Department of Obstetrics & Gynecology, we hold dual academic appointments at both Case Western Reserve University’s Frances Payne Bolton School of Nursing and in the Department of Reproductive Biology at  Case Western Reserve University School of Medicine.

The Division of Nurse-Midwifery serves not only expectant mothers, but also provides comprehensive well-woman care at all stages of life. Our services include annual exams, preventative services including mammograms and pap tests, discussing and prescribing birth control, and providing perimenopausal and postmenopausal care.

Our division provides women with the best of both worlds — highly personalized health care with evidence-based medicine. Using a multidisciplinary approach, we work closely with obstetricians, gynecologists and the Department of Maternal Fetal Medicine at UH MacDonald Women’s Hospital to ensure a safe, healthy and positive experience for every  pregnancy and birth.

As the largest midwifery practice in the Cleveland area, we have the greatest volume of births. In 2013, our nurse–midwives attended 1087 vaginal births and our primary cesarean section rate was only 8.9%. Our division also supports vaginal birth after cesarean section (VBAC), and in 2013 our patients attempting VBAC experienced a successful vaginal birth 72% of the time. Both of these statistics are significantly better than the national averages

Along with traditional outpatient services, the Division of Nurse-Midwifery takes a personalized approach to pregnancy and birth. We offer unique services like CenteringPregnancy® and water birth in order to improve patients’ pregnancies and birth experiences. From having family members present for the birth of the baby, to guiding each patient’s journey through a water birth, we tailor the birth experience to the patient’s individual needs and preferences. 

Nurse-midwifery care focuses on teaching, not only patients, but also RNs enrolled in nurse-midwifery and nurse practitioner education programs, medical students and resident physicians.  The midwives are instrumental in the education of these medical professionals in the normal gynecology and obstetric care.  Eight midwives currently lecture in the medical student third year OB/Gyn clerkship series, while the director of the midwifery service also serves as the Assistant Director of the Clerkship.  For the residents, the midwives are fundamental instructors of normal labor & birth during the internship first year.  It is a relationship that continues to evolve through their four-year residency and cultivates their professional development as chief residents through collaboration and consultation

CenteringPregnancy®

CenteringPregnancy® provides pregnant women with prenatal care in a group setting.  It incorporates health assessment, health promotion and education.   At University Hospital Women's Hospital, approximately 40% of the patients we serve are indigent African-American women who are at highest risk for poor prenatal outcomes.   We are aware of the challenges of our patient population:  low income, single parent families, low educational achievement and few social supports in the home setting.   With the complex social lives that our patients face, Centering is proven means to address the gaps of racial disparity in healthcare as women network with each other for support. 

The CenteringPregnancy® program at University Hospitals addresses not only the physical needs of the patient, but the emotional needs of the young mothers.   The program provides participants with a dynamic atmosphere for learning and sharing that is impossible to experience through a one-on-one prenatal visit with a healthcare provider.   Participants have voiced how important it is to be able to share their pregnancy experience as well as hear other women’s experience which helps normalize the pregnancy and the birth process.   This experience can help decrease feelings of isolation and loneliness, and help combat depression in pregnancy as well as postpartum depression.   Additionally, the knowledge many pregnant young women learn in this environment can directly impact and improve their health and the health of their baby. 

The program currently is self-sustaining, having relied on grant support for startup costs from the Kaiser Family Foundation, the March of Dimes and Wellpoint Foundation. The March of Dimes provided $5000 in 2013 to help improve nutrition knowledge thus decreasing low birth weight in the target population. The program seeks grant support to expand efforts in weight control, mindfulness, and physical activity in pregnancy.

CenteringParenting

In Spring 2012, at the request of our patients, CenteringParenting was begun in coordination with the Family Medicine Department. The Centering babies are seen for their usual well child appointments and receive their scheduled vaccinations. The Centering mothers receive their post-partum check up, depression assessments, birth control methods and annual exam as part of those visits, too. Thus the mother baby dyad can have a“one stop shop” for many of their health care needs. In addition mothers receive support in the group setting for parenting and nutrition, and learn to read and sign to their children. 

Additional Information.